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This Evolving is an Malnutrition Example Care of the through Main Title of a Presentation: Quality Improvement and Measurement CNM DPG And Symposium This is Where 2017the Subtitle Would Monday, March

1 This Evolving is an Malnutrition Example Care of the through Main Title of a Presentation: Quality Improvement and Measurement CNM DPG And Symposium This is Where 2017the Subtitle Would Monday, March Appear 20, 2017 with 10:15 More am Info 11:15 am St. Petersburg, Florida Sharon McCauley --- Senior Director, Quality Management Academy of Nutrition and Dietetics Developing nutrition-related quality measures is a member-driven strategy for the profession to lead healthcare quality Quality Management Committee Recommendation for Academy Quality Strategies Goals, Strategies/Tactics and Initiatives for Quality Strategies Goal STRATEGIES/TACTICS INITIATIVES 1. Lead the development of food, nutrition and dietetics national quality measures to support regional/national initiatives and demonstrates impact. 1. Modify the Academy s current structure to support the Quality Improvement aligned with National Quality Strategy (NQS) 2. Allocate sufficient resources to support a comprehensive approach to quality measures initiatives 3. Explore opportunities for lack of national quality measures for food, nutrition and dietetics profession 4. Develop, test, implement and communicate nutrition and dietetics quality measures to demonstrate outcomes Communicate to the Academy CEO and submit addition of a Strategic Theme to the BOD: Provide safe and effective care of the highest quality and value to add to the Academy Strategic Plan Goal Strategy Pursue, as a Steward, NQF endorsed measure related to Food, Nutrition and Dietetics service and delivery Form a Nutrition Quality Alliance to collaborate with external stakeholders to develop a measure on malnutrition and dehydration Develop and utilize quality measures to increase job equity as payment for health outcomes is currently the quality national program (value based purchasing, buying value common measures and meaningful use); CMS hospital reimbursement based on 3 items = core measures. HCAHPS [Hospital Customer Assessment of Healthcare Providers and Systems], patient safety initiatives Seek additional collaboration with other organizations to develop quality measures 2 1

Quality Strategy Implementation Accomplishments and Next Steps Developing malnutrition electronic clinical quality measures (ecqms) for inclusion in CMS quality programs 2013 Proposal and approval to

2 Quality Strategy Implementation Accomplishments and Next Steps Developing malnutrition electronic clinical quality measures (ecqms) for inclusion in CMS quality programs 2013 Proposal and approval to develop quality measures 2014 Established as a measure steward with NQF 2015 Established Collaborations to develop and test ecqms 2016 Submit ecqms to CMS and NQF 2017 Target for inclusion in CMS Quality Program Project support provided by Abbott and Avalere Health 3 Today s Discussion on Malnutrition Quality Improvement Initiative (MQii) Overview MQii Toolkit and Learning Collaborative Malnutrition Composite Measure Advocacy, Engagement, Communication 4 2

Malnutrition Reduces Overall Health and Contributes to Increased Readmission Rates MALNUTRITION HAS AN IMPACT ON PATIENT RECOVERY AND METRICS SUCH AS READMISSIONS AND MORTALITY

3 Malnutrition Reduces Overall Health and Contributes to Increased Readmission Rates MALNUTRITION HAS AN IMPACT ON PATIENT RECOVERY AND METRICS SUCH AS READMISSIONS AND MORTALITY Malnutrition-associated outcomes include depression of the immune system, impaired wound healing, and muscle wasting 1 Leads to higher readmissions rate 1 relative to well-nourished patients and increased mortality 2 1 Alliance to Advance Patient Nutrition Staff. The Facts on Malnutrition: What every health care professional needs to know now about patient nutrition. Alliance to Advance Patient Nutrition. Available at: Published Accessed February 3, Barker LA, Gout BS, and Crowe TC. Hospital malnutrition: Prevalence, identification, and impact on patients and the healthcare system. Int J of Environ Res and Public Health. 2011;8: Malnutrition is a Quality Issue Lack of consistent screening with a validated tool Lack of diagnosis compared to published estimates of prevalence Lack of treatment of those identified as malnourished Lack of monitoring of status = poor quality care 6 3

4 What Does it Take to Develop a Quality Measure? 7 This is an Example of the Main Title of a Presentation: Malnutrition Quality Improvement Initiative MQii And This is Where the Subtitle Would Appear with More Info Overview 4

5 What is the Malnutrition Quality Improvement Initiative (MQii)? MQii Objectives Advance adoption of malnutrition electronic clinical quality measures (ecqms) that matter Improve effectiveness and timeliness of malnutrition care through an interdisciplinary toolkit Support availability of tools that can be integrated into EHR systems to improve care quality The MQii is focused on older adults (ages 65 and older) given the significant impact malnutrition has on this patient population and the opportunity to improve care among these patients 9 The MQii Offers a Solution to Enhance the Quality of Malnutrition Care Malnutrition Care Workflow Screening* Nutrition screening using a validated tool for all patients with a hospital admission Assessment* Nutrition assessment using a standardized tool for all patients identified as atrisk for malnutrition Diagnosis* Documentation of nutrition diagnosis for all patients identified as malnourished Care Plan Development* Establishment of a nutrition care plan for all patients identified as malnourished or at-risk for malnutrition Intervention Monitoring/ Implementation Implementation of a nutrition care plan including treatment for all patients identified as malnourished or atrisk for malnutrition Evaluation & Discharge Planning Implementation of processes, including discharge planning, that provide ongoing monitoring and support the care of patients identified as malnourished or at-risk for malnutrition The MQii is based on patient-driven nutrition practices that include patient preferences and risk factors *These steps in the care workflow have an ecqm associated with them. 10 5

6 The MQii Provides Tools to Achieve Care Goals The MQii Toolkit provides practical resources to enable hospitals to achieve optimal nutrition standards of care MQii Toolkit Implementation GOAL: Achieve Malnutrition Standards of Care MQii ecqm Adoption Data reported from ecqms will help hospitals demonstrate if and by how much they are successful in meeting the standards of care 11 Malnutrition Electronic Clinical Quality Measures (ecqms) NQF #3087 / MUC16-294: Completion of a Malnutrition Screening within 24 Hours of Admission NQF #3088 / MUC16-296: Completion of a Nutrition Assessment for Patients Identified as At-Risk for Malnutrition within 24 Hours of a Malnutrition Screening NQF #3089 / MUC16-372: Nutrition Care Plan for Patients Identified as Malnourished After a Completed Nutrition Assessment NQF #3090 / MUC16-344: Appropriate Documentation of a Malnutrition Diagnosis *Measures were submitted to the National Quality Forum (NQF) for potential endorsement and to CMS for adoption into the HIQR Hospital Inpatient Quality Reporting For more information: and

7 ecqmstested to Assess Feasibility and Validity THE FOLLOWING IS A LIST OF SITES WHERE THE MEASURES WERE TESTED Feasibility of ecqm Concepts Feasibility Testing Sites Advocate Hospital University of Iowa Hospitals and Clinics Cleveland Clinic Validity of ecqm Concepts Field Testing Sites Advocate Hospital University of Iowa Hospitals and Clinics Feasibility Testing EHR Vendors EPIC Cerner AllScripts 13 This is an Example of the Main Title of MQii a Presentation: Toolkit And This is Where the Subtitle Would Appear with More Info Learning Collaborative

Toolkit Tested at a Variety of Sites as Part of a Demonstration and Learning Collaborative Learning Collaborative Site Demonstration Site MQii Toolkit Learning Collaborative Site Learning

8 Toolkit Tested at a Variety of Sites as Part of a Demonstration and Learning Collaborative Learning Collaborative Site Demonstration Site MQii Toolkit Learning Collaborative Site Learning Collaborative Site Learning Collaborative Site Participating Sites Included: Vanderbilt University Medical Center UC San Diego Health System (Demonstration Site) University of Iowa Hospitals and Clinics Spring Valley Hospital West Virginia University Hospital Tampa General Hospital 15 Toolkit was Tested in Hospitals Nationwide that Varied in Size and Type 16 8

Open Access MQii Toolkit Is Available at www.mqii.

9 Open Access MQii Toolkit Is Available at Tools and Resources Patient Engagement Staff Education Tools Quality Improvement Data Management 17 MQii Toolkit and ecqms Are Supported by Multi-Stakeholder Input Advisory Committee Toolkit design and implementation informed by representatives from: Technical Expert Panel Measure development informed by representatives from: MQii Toolkit Development MQii ecqm Development CMS Approach informed by regular communication with CMS to ensure alignment with CMS quality goals and adoption of best practices for a quality improvement demonstration 18 9

Engagement with CMS to Discuss Integrating Malnutrition Quality in National

Moody Williams, RN, MPP Deputy Director CMS Center for Clinical Standards and

Quality CMS Chief Medical Officer Shari Ling, MD Deputy Chief Medical Officer CMS

for Patients CMS Center for Clinical Standards and Quality 19 Ensuring Hospital

10 Engagement with CMS to Discuss Integrating Malnutrition Quality in National Quality Programs Jean D. Moody Williams, RN, MPP Deputy Director CMS Center for Clinical Standards and Quality Kate Goodrich, MD, MHS Director of the Center for Clinical Standards and Quality CMS Chief Medical Officer Shari Ling, MD Deputy Chief Medical Officer CMS Center for Clinical Standards and Quality Paul McGann, MD Co Director Partnership for Patients CMS Center for Clinical Standards and Quality 19 Ensuring Hospital Adoption of ecqms THE ACADEMY AND AVALERE WILL ESTABLISH A MQii LEARNING COLLABORATIVE 2.0 IN 2017 TO SUPPORT ecqm ADOPTION The goals of the MQii Learning Collaborative 2.0 are twofold: 1. Bring together learning health delivery organizations to further test and generate evidence on malnutrition care best practices 2. Implement MQii tools under real-world circumstances to support acceleration and dissemination of optimal malnutrition care practices across the U.S 20 10

11 Resources on Malnutrition 21 emeasures Resources 22 11

12 Measures Specifications Manual 23 ecqms Details 24 12

13 External Resources on Malnutrition 25 Defeat Malnutrition Coalition 26 13

14 This is an Example of the Main Malnutrition Title of a Composite Presentation: Measure And This is Where the Subtitle Would Appear with More Info Malnutrition Composite Measure Model Global Malnutrition Score Objective: measure how well hospitals comply with recommended steps of malnutrition care including: screening assessment diagnosis intervention/care plan Running simulation testing on this model using simulated data and original testing data from our first phase of measure testing 28 14

15 Status of Learning Collaborative enrolled individual facilities across 10 health systems Undergoing feasibility assessments ensure collect measure data as specified in the measure Goal each site collect initial run of data April 2017 Sites implement a 3-month Quality Improvement (QI) project use the accompanying MQii Toolkit track and monitor performance on the ecqms 29 Learning Collaborative 2.0 will Elevate Malnutrition Quality Improvement at a National Level 30 15

16 This is an Example of the Main Advocacy Title of a Presentation: Engagement And This is Where the Subtitle Would Appear with More Info Communication Advocating for Malnutrition Quality Measures through NQF and CMS Pathways Communication Timeline Estimated Timing November 2016 January 2017 CMS 2016 Measures Under Consideration (MUC) published and open for comment Malnutrition measures included in MUC list April June 2017 CMS releases draft Hospital Inpatient Quality Reporting (IQR) Program Rule for FY2018 Open for comment [Potential for malnutrition ecqms to be included] October 2017 FNCE Chicago MQii Sessions Pending CMS inclusion of malnutrition ecqms in final Hospital IQR Rule for FY2018, Acute care integration of malnutrition quality measures [official data collection begins CY 2019] March 2017 CNM DPG Session NQF submits report to HHS with recommendations for CMS MUC [Potential for NQF comments on malnutrition ecqms] August 2017 CMS releases final Hospital IQR Rule for FY2018 [Potential for malnutrition ecqms to be included] 32 16

17 This is Advisory an Example Committee of the Main Title of a Presentation: And This is Where the Subtitle Would Appear with More Info Technical Expert Panel for emeasures Malnutrition Quality Improvement Initiative Advisory Committee Alison Steiber, PhD, RDN; Chief Science Officer, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics Ann Watt, MBA, RHIA; Associate Director, Department of Quality Measurement, Division of Healthcare Quality Evaluation, The Joint Commission Evelyn Granieri, MD, MPH, MSEd; Professor of Medicine, Chief, Division of Geriatrics Medicine and Aging, and American Geriatrics Society Howard Bregman, MD, MS; Director of Clinical Informatics, EPIC Karim Godamunne, MD, MBA, SFHM; Chief Medical Officer, North Fulton Hospital/Tenet Health System Leslie Kelly-Hall; Senior Vice President, Policy, Healthwise (Patient Advocate) Maureen Dailey, PhD, RN, CWOCN; Senior Policy Advisor, Health Policy, American Nurses Association Peggi Guenter, PhD, RN, FAAN; Senior Director of Clinical Practice, Quality, and Advocacy, American Society for Parenteral and Enteral Nutrition Refaat A. Hegazi, MD, PhD, MPH, MS, Global Medical Director, Research & Development, Abbott Nutrition 34 17

18 Malnutrition Quality Improvement Initiative ecqm Technical Expert Panel Albert Barrocas, MD; Chief Medical Officer, Atlanta Medical Center Karim Godamunne, MD, MBA, SFHM; Chief Medical Officer, North Fulton Hospital/ Tenet Health System Trisha Fuhrman, MS, RDN, CNSD, LD, FADA, FAND; Malnutrition / Nutrition Support Specialist, Ballwin, Missouri Sue Kent, MS, RDN, LD; Clinical Informatics Systems Analyst, Cleveland Clinic, Ohio Ginny Meadows, RN, FHIMSS; Vice President, Regulatory Strategy, McKesson Louise Merriman, MS, RDN; Director, Clinical Nutrition, New York - Presbyterian Melissa Parkhurst, MD; Associate Professor, University of Kansas Medical Center Eleanor Perfetto, PhD; Senior Vice President, Strategic Initiatives, National Health Council (Patient Advocate) Donna Quirk, MBA, RDN, LD; Clinical Nutrition Management, Lexington Medical Center, South Carolina Marty Yadrik, MS, MBI, RDN, FAND; Director, Nutrition Informatics, Computrition Angel Valladares, MPH; Manager, Avalere Health Sharon McCauley, MS, MBA, RDN, LDN, FADA, FAND; Senior Director, Quality Management, Academy of Nutrition and Dietetics 35 This is an Example of the Main Title of a Presentation: Questions? And This is Where the Subtitle Would Appear with More Info 18

Malnutrition Advocacy Training. This is an Example of the Main. Title of a Presentation:

Malnutrition Advocacy Training Nadine Braunstein, PhD, RD, LDN, CDE This is an Example of the Main Chair, Legislative and Public Policy Committee Title of a Presentation: Jeanne Blankenship, MS RDN And